Electronic medical alerts don't ensure timely response
Electronic medical alerts no guarantee of timely response
Published 5:30 am, Tuesday, September 29, 2009
Even when notified by electronic e-mail alerts, doctors sometimes ignore test results that show the patient might have a serious condition, according to a Houston study.
The study, conducted at the Michael E. DeBakey Veterans Affairs Medical Center and its clinics, found doctors failed to follow up within a month on nearly 8 percent of such alerts. The alerts involved abnormal results, some later diagnosed as cancer, on imaging tests such as MRIs and X-rays.
“This shows we still have a lot of work to do,” said Dr. Hardeep Singh, a Baylor College of Medicine professor and VA administrator who led the study. “It also shows you can't just install an electronic system and assume it'll work optimally. There's a human factor.”
The study, published Monday in the Archives of Internal Medicine, nonetheless showed an improvement over paper-based systems, in which records are mailed or faxed, said Singh. In a 2004 Harvard study in which paper-based systems were used, 64 percent of women whose mammograms showed abnormal results received timely follow-up.
President Barack Obama has pushed for electronic medical record-keeping as part of his health-care reform efforts, including the announcement last month of $1.2 million in grants to help doctors and other providers make the conversion.
Obama and other advocates argue electronic records will increase efficiency and lead to a higher quality of health care.
VA hospitals have been in the forefront of the movement. Many have used electronic records for nearly a decade now.
To determine how well it was working, Singh looked at 1,196 abnormal test results between November 2007 and June 2008 that generated alerts to the VA clinician who ordered them. Timely follow-up with patients did not occur following 92 of alerts, including 7.3 percent that were read and acknowledged by the doctor and 9.7 percent that weren't.
The follow-up was even less likely to occur when more than one clinician received the alert, said Singh, perhaps because both assumed the other would take care of it.
Follow-up was more likely to occur when a radiologist also communicated concerns about the result verbally.
The 92 alerts showed potential aneurysms, cancers and spinal cord problems. In nearly all lacking timely follow-up, the conditions got worse.